By Bashir Hassan Abubakar
Bauchi State Government, health experts, elites and other concerned citizens have, at several fora expressed worries over the persistent health indices, especially on maternal and child deaths,and the accompanying pain, anguish and despair that usually comes with such lose.
Though at the moment the only reliable data on maternal death in Bauchi State is that of the NDHS 2018, projections from current surveys on maternal health status of women in the State , pointing to the insignificant change in the indices , leaves much to be desired, in the quest to mitigate maternal mortality rate in Bauchi State.
According to Multiple Indicator Cluster Survey (MICS) 2021, delivery assisted by any skilled attendant in Bauchi State is only 17.4 percent, while ANC (at least 4 visits) by any provider is 43.3 percent and ANC (at least 1 visit by skilled provider is 42.5 percent. The MICS 2021 also indicated that post natal health care check for mothers is 40.4 and women protected against tetanus is put at 57.8 percent.The survey also revealed that, women aged 15-49 years who received appropriate care in Bauchi State are less than the Northeast region and National rates.
Also the survey indicated that early childhood death rates are higher in Bauchi State compared to the rates for the north east and national rate of children dying.
As contained in the MICS 2021, under-five mortality per 1000 live birth is 153 which is above the national average of 102 and the entire north east that stands at 114. Child mortality rate in Bauchi stand at 70 per 1000 live birth and infant mortality rate is 89. Post neonatal and neonatal mortality rates in Bauchi State are 43 and 45 per 1000 live births. (MICS 2023).
From the above statistics, perinatal and early childhood death rates are higher in Bauchi State compared to the rates for the north east and national rate of children dying.
Most of these deaths, according to health experts are not reported as pregnancy or birth related deaths at the community or, even health facility levels.
The above validated statistics is more than enough reasons to upset any right-thinking Government or any concerned citizens of Bauchi State, because pregnancy or giving birth are not diseases and most of these deaths are preventable.
Thus, when the federal government of Nigeria through the federal ministry of health adopted a World Health Organization’s (WHO) concept known as Maternal, Perinatal and Child Death Surveillance and Response (MPCDSR), State Governments and other key stakeholders in the health sector saw it as an innovative approach to reduce, to barest minimum, maternal and child deaths in Nigeria.
Maternal, Perinatal and Child Deaths Surveillance and Response (MPCDSR) according to WHO, is a form of continuous surveillance that links the health information system and quality improvement processes from local to national levels, which includes the routine identification, notification, quantification and determination of causes and avoid ability of all maternal, perinatal and child deaths, as well as the use of this information to respond with actions that will prevent future deaths of women , newborn and children.
The primary goal of MPCDSR is to eliminate preventable maternal, perinatal and child mortality by obtaining and using information on each maternal, perinatal and child death to guide public health actions and monitor their impacts.
MPCDSR expands on ongoing efforts to provide information that can be used to develop programmes interventions for reducing maternal, perinatal and child morbidity and mortality and improving access to and quality of care that women and children receive during pregnancy, delivery, the puerperium, and childhood.
MPCDSR aims to provide information and data that will lead to specific recommendations and, actions and improve the evaluation of their effectiveness.
Bauchi State Government is not unaware of the challenges in its health sector. So, when the MPCDSR concept was advocated for, the Government did not waste time in keying into it. This, it did, with a view to further raise the bar in reversing the worrisome trends in its health care systems.
With the technical support of GATES Foundation funded intervention known as Evidence 4 Action Mamaye (E4A) Project, a State Steering Committee on MPCDSR was formed with the mandate of providing the State Government with intermittent forensic information and recommendations on how to reduce maternal, newborn and child deaths in-line with concept approach of MPCDSR.
Composition of the steering committee was drawn from all health related state MDAs, professional bodies and an Evidence Based driven Bauchi based CSO known as Bauchi State Accountability Mechanism for MNCH (BaSAM).
From the onset, the steering committee knew the herculean tasks that awaits them and most of MPCDSR tasks are technically driven and so, there is the need for strengthening the technical capacity of those saddled with the responsibility of the MPCDSR tasks.
The E4A Mamaye Project has done its best in providing technical support to the steering committee and they were always on ground to facilitate and support review meetings of the steering committee. Rotary International too had supported the State MPCDSR steering committee through capacity building program and the cascading of such trainings to the LG personnel. All these were carried out with a view to inculcating the culture of maternal and child deaths audits at both the health care facility and community level.
As it is with every pilot initiative, people saddled with the responsibility of making it viable always needs a push and proactive leadership to excel and even mentor others to tow the same path.
It was glaring after the exit of E4A Mamaye Project the Bauchi State MPCDSR Steering Committee had also gone to sleep too, thus negating the purpose of keying into MPCDSR concept as a tool deployed to reduce preventable Maternal and Child Deaths in Bauchi State.
USAID IHP TO3 to the Rescue
When USAID funded Integrated Health Program (USAID IHP) Intervention debut in Bauchi State, it came with an innovative approach to supporting the State to reverse the disturbing trends associated with maternal and child deaths, which is aimed at improving MNCH services.
The USAID IHP intervention provides system strengthening through capacity building of healthcare service providers. Other interventions of IHP were also focused on donation of commodities and equipment for enhanced service delivery. Hand in hand with the above interventions and in line with its sustainability plan, USAID IHP also mentored CSOs and the media to advocate for improved health care services in Bauchi State. The intervention further built the capacity of CSOs and the media coalition that is carrying out advocacies that triggers enrollment of Bauchi citizens into the State Health Contributory Scheme, as a pathway to achieving Universal Health Coverage (UHC), that aims to reduce out of pocket expenditure for the people.
So, when USAID IHP task order 3 observed how the State MPCDSR Steering Committee were becoming quite and ineffective, it quickly swung into action by organizing a three day intensive capacity training. The training attracted the entire membership of the Committee, Representatives of WHO, UNICEF, Pediatrician Association of Nigeria (PAN), Nigeria Medical Association (NMA), PLAN International, Journalists for Public Health and Development Initiative (J4PD) and Breakthrough Action Nigeria (BAN) amongst other participants.
At the capacity training meeting, held in Azare Town, between 26th – 28th April 2023, the State MPCDSR Steering committee took lead in facilitating the sessions, with the team from USAID IHP TO3, led by its Technical Director Dr. Ibrahim Kabo and Human Resource Advisor Dr. Robinson Yusuf, providing the much needed technical support during the the training.
One interesting aspect of the training was the presence of the Bauchi State Commissioner of Health, Dr. Sabiu Abdu Gwalabe and the permanent secretary of the ministry Aliyu Babayo Gamawa all through the three days training. By default, the every commissioner of health automatically becomes the chairman of the Steering Committee. During the training meeting, the commissioner chaired and moderated all the sessions, bringing his vast experience as medical practitioner to bear.
It is worth mentioning that, since his assumption into office as Commissioner of health, Dr. Gwalabe has demonstrated his technical skills as a practicing medical Doctor and his vast knowledge of the healthcare system in Bauchi State. This, he did, with a view to proffering a realistic solution to some of the challenges the State is facing in it’s healthcare service delivery, especially in the manpower gap in human resource.
Dr. Gwalabe came into office, prepared, with a blue print on how to contribute his quota for the development of the Bauchi State health sector. He has the required competence and technical skills in doing that.
His unassuming nature, level headedness and leadership qualities has endeared him greatly in the hearts of the staff of the ministry, with most of them hoping and praying fervently for him to retain his portfolio, as cabinet member in the second tenure of the current administration of Governor Bala Abdulkadir Mohammed.
Some of the modules presented to the participants were:
– Concepts, Philosophies of Medical and Death Audits and Evolution of MPCDSR in Nigeria
– Formation and Functions of MPCDSR Steering Committee at Federal, State and LG Levels
– Conducting MPCDSR Using the Health Facility Tools
– Legal Issues and Legislation on MPCDSR and
– Establishing and Conducting MPCDSR at Health Facility Level
Other modules presented were centered around Trends of Maternal, Perinatal and Child Mortality at Global, Regional and National Patterns and, Reporting, Monitoring, Evaluation and Research in MPCDSR etc.
The presentations also elicited comments, observations, questions, answers and general discussions from participants, that was engaging as well as productive and was moderated by the State Commissioner of Health, Dr. Sabiu Gwalabe.
Participants were also exposed to a hands-on practical simulation on how to conduct MPCDSR. The participants were divided into 3 groups, with each group given a specific case scenario. After studying the case, they then went back to populate the different forms that will bring out the medical audit of each case scenario, showing direct and indirect causes of deaths of either pregnant woman, newborn, infant, child or under-under five. Afterwards, the each presented their findings at plenary, where each audit report of the 3 groups were subjected to scrutiny, pointing lapses in reporting and further revealing how the check lists on the forms should have been administered, looking at each case scenario.
The simulation group exercise was an interested sessions that brought together medical personnel, health administrators, CSOs and the media, exposing them to a first hand experience of what MPCDSR entails.
One of the key outcome of the training was the adoption of the recommendation on the need to bring tertiary health institutions , that is, the Abubakar Tafawa Balewa University Teaching Hospital and Federal Medical Center Azare into the membership of the state MPCDSR steering committee.
Another key outcome of the training was the formation of 3 Sub-committees that will support the steering committee in fast tracking implementation of the MPCDSR concept in some of the selected health facilities across the state. This will eventually cover all the health facilities, including private ones, in all the 323 wards of Bauchi State.
The co-opting of 2 members of Journalists for Public Health and Development Initiative (J4PD), a media based CSO, into the Advocacy Sub-committee was seen by many stakeholders as a master-stroke that would give visibility to the activities of the newly re-jigged state MPCDSR steering committee and further create more awareness, through evidence based advocacy, using all channels of communication for wider reach.
There were other recommendations at the end of the capacity training that were focused on improving the capacity of the old and new entrants of the state MPCDSR steering committee of which participants and USAID IHP all agreed that it is a right step in the right direction.
With the resuscitation of the State MPCDSR steering committee, chaired by Dr. Gwalabe and the practical demonstration of its members to carry out it’s responsibilities, all is left is for the Bauchi state government to provide the financial support and enabling environment for the implementation of this foolproof MPCDSR initiative, that is geared towards providing evidence information and recommendations on measures to adopt in mitigating maternal and child deaths, thus reversing the ugly trends in maternal, newborn and child health in Bauchi State.
End
(Some of the pictures used in this are for illustrative purposes only)